NHS #WTF? – How Has It Come to This?

NHS last as long

When I first arrived in England, I was handed a medical card and my first thoughts were that either it was crazy, or a brilliant idea. Growing up in Ireland, I watched my mum saving receipts year after year for the Voluntary Health Insurance annual return. I still wonder to this day, what happens to the people who don’t qualify for a medical card, yet are unable to afford the VHI contributions.

Twenty years on, I am proud to say that I work in one of the best healthcare systems in the world. The NHS consistently ranks in the top 20 World Health Organisation’s rankings of best global healthcare systems, since 2000, way ahead of other developed nations such as the US and Australia.  In a 2014 report by the Commonwealth Fund, the NHS ranked first in several indicators such as safety, effectiveness, efficiency, patient-centredness and co-ordination of care.

Our beloved system however, needs some serious resuscitation.  Due to what is now widely acknowledged as severe underfunding and negative interference by successive governments, the future of the NHS is in grave danger.

As usual, all good press gets buried by the major media outlets. The latest consultation on the future of the NHS, where the public gets to have their say, was as good as buried. There is very little in the way of integrated discussion of how things have gotten this bad.

Many healthcare workers of all disciplines, that I speak to on a daily basis, are of the belief that the NHS is being systematically underfunded, so that it can be called broken, leaving it wide open for the private sector to fill the gap. This has already begun by stealth.  Support services such as Estates, Housekeeping and Sterile Services have been outsourced in many NHS trusts for some time. Private consortiums now run out of hours GP services and operations are outsourced to the private sector. This may be good for efficiency, but often actually costs the NHS more.

The building of new hospitals has been almost wholly outsourced to the Private Finance Initiative (PFI).  This is a particularly neat scheme, which will build a new hospital, then rent it back at x rate for a minimum of 30 years, while retaining the contract for maintenance that the Trust pays for.  Ownership reverts back to the Trust at the end of the lease.

What no-one talks about is how difficult it will be to get any maintenance done on that building during that 30 years; how long you will have to wait to get a door closer fixed.  Then there is the aspect of building under PFI that means if the light switch hasn’t been written into the plans, it won’t be included in the building. It will be very interesting to see the state of these buildings when they are finally handed back to the NHS and after the financial havoc wreaked on the NHS as a whole.

One of the worst things is that healthcare workers’ terms and conditions have been under attack for some time now.  If the government gets to push through these unsafe changes, it not only gets to continue underfunding the NHS, it can also lay the blame at the door of healthcare workers, thereby providing it with a convenient scapegoat.

The latest attack on the NHS comes in the form of proposals to change the Junior Doctors contract. If these proposals go through, it will shove the faces of an already demoralised workforce into the mud all the harder.  What the general public does not really realise, is that “Junior Doctor” means every doctor other than a consultant or General Practitioner (GP).  The proposals mean that all junior doctors will work more and harder, earn as much as £15,000 less pa, and have the legal right to a proper break on a twelve hour shift removed. The threats that these proposals pose to patient and staff safety are self-evident.


I have done the twelve hour shifts alongside these doctors; they don’t get food or toilet breaks as it is, yet they drop everything and come when they are called, night and day, to stop people getting sicker and save lives. Doctors who work part time (invariably women with children) will not be able to make ends meet and so not only will the NHS lose talented doctors, it will also become a discriminatory workplace.

Junior Doctors, most of whom are members of the British Medical Association, have voted to go out on a series of strikes by an unprecedented majority of 98%. The last time doctors ‘went on strike’, it was more of a work to rule.  The current proposal for a series of three strikes has much farther reaching consequences.

The Junior Doctors are, on some level, going out for all of us.

Nurses* in particular, do not go on strike, largely out of a fear of disciplinary action, but also because the Royal College of Nursing (RCN), the biggest nursing union in the UK, does not truly support strike action by its members, with a stipulation about patients not coming to harm.

Nurses are working longer and harder, in a background of continual change, both to the service infrastructure and equipment they use to deliver care.  An enormous amount of the mandatory continuing professional development requirements imposed on all healthcare professionals already takes place in their own precious off-duty time.

This is what’s been happening to the nurses since 2008:

  • Government reneged on a pay deal made in 2008, promising 3% that year, 2% in 2009 and 1% in 2010. Nurses only saw the first year of that promise.
  • There has been no rise in salary, except through the increment system. Nurses at the top of the increment who don’t move banding will not see any extra money at all.
  • When everything is taken into account, nurses have taken a real terms pay cut of nearly 10% since 2008.
  • Nurses already don’t get their breaks – time the NHS does not pay them for and most never get the time they are owed back; whether it’s through not being able to take their break, or having to stay behind to either ensure situations are safe, or something essential gets done.  Nurses also do all of this, all the time.
  • NHS Pension terms and conditions have been drastically altered, while the minimum contribution has been forcibly raised. Combined with the higher retirement age being imposed on everyone, this means most healthcare workers will be working longer and harder, for less return.
  • The latest attack is on student nurse and midwife bursaries, which the government proposes should be scrapped altogether. This means that students will basically be turned into unpaid skivvies, undervalued before they even begin practising as qualified. They will then graduate with debt. This will likely lead to serious problems with recruitment as students cannot afford to study and will not apply for or complete courses.
  • Time given over to professional development has been cut year on year.
  • The new revalidation requirements coming into force by the Nursing and Midwifery (NMC) council in 2016 are very likely to take more hours to complete than under the previous system of PREP.
  • All of the above means nurses are being asked to do more with less, year on year.

Lately there has been the much trumpeted figure of a several billion cash injection into the NHS. However, proper examination of this proposal reveals that it would effectively mean a 20% overall reduction in funding across the NHS as a whole, in order to come up with the money.

Apart from the obvious reasons of why people in the UK should be seriously concerned about any of this, there are additional reasons why people in Ireland should be concerned:

  • Irish family and friends in the NHS face continuing sustained financial pressure, while working longer and harder, in a culture that undervalues their contribution to society.
  • Irish people who need to travel to the UK for treatment that can’t be carried out in Ireland face increased bills, especially if care becomes privatised.
  • The thousands of women who travel to the UK for abortions every year.
  • Young Irish who intend to train in the UK may face an increased burden of debt

The NHS is one of, if not the best, healthcare system in the world. It is safe, efficient and patient centred – I would have no hesitation in having a member of my family treated by the NHS.

It would be very foolish to stand by and watch it being dismantled piece by piece, which is what will happen if things continue on the current track.

It would be impossible to resuscitate it.

OlympicNHS image

The term *Nurses* as used here, encompasses nurses, midwives, operating department practitioners, healthcare assistants and many other staff who are subject to the same terms and conditions.

Barbara O’Donnell

#saveournhs #LoveYourNHS #bigupthenhs #NHSunited #NotFairNotSafe #juniordoctors #juniorcontract #nhs #patientsafety #healthcare #hearnursesroar #odp #midwife #StrongerTogether #IminworkJeremy